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DOI: 10.1055/s-0029-1191370
The change from aprotinin to aminocaproic acid: Results of a single center pair-matched study on renal failure, bleeding and revision rates
Objectives: Fibrinolysis and platelet dysfunction is a common occurrence after cardiac surgery with cardiopulmonary bypass. This may result in excessive blood loss. Antifibrinolytic drugs like aprotinin (AP) and aminocaproic acid (AC) prevent this. Adverse events of aprotinin have been discussed controversially. This lead to an official FDA warning. We compared aprotinin to aminocaproic acid in terms of postoperative renal function, bleeding and revision for bleeding or tamponade.
Methods: Out of 7000 consecutive cardiac cases, 230 patients receiving full dose aprotinin were pair-matched to 230 patients receiving aminocaproic acid. Patients underwent cardiac surgery on cardiopulmonary bypass in a single center. We matched according to every single parameter of the Euroscore and type of illness.
Results: Postoperative blood product transfusion was similar in the aprotinin and aminocaproic acid group. Patients receiving aprotinin and aminocaproic acid showed congruent amounts of total blood loss (1335ml versus 1300ml, p=0.173). Postoperative renal function and dysfunction revealed no differences between the groups. Tamponade and re-thoracotomy for bleeding occurred less frequently in the aminocaproic acid group than in the aprotinin group (3.5% versus 7.7%, p=0.64). Length of ICU stay was increased in the aprotinin group (2.26d AP versus 1.60d AC, p=0.054).
Conclusion: The change to aminocaproic acid neither lead to an improvement in renal function nor caused an increase in blood loss or need for transfusion. Revision rates for excessive bleeding or tamponade were more than halved in the post aprotinin era and length of ICU stay clearly reduced, a phenomenom which has to be discussed further.